Provider Demographics
NPI:1306517115
Name:FLORES, KEVIN CHRISTIAN PINEDA (CRNA)
Entity type:Individual
Prefix:
First Name:KEVIN CHRISTIAN
Middle Name:PINEDA
Last Name:FLORES
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:KEVIN
Other - Middle Name:
Other - Last Name:FLORES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:1819 IRON HORSE DR
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-7180
Mailing Address - Country:US
Mailing Address - Phone:919-961-7417
Mailing Address - Fax:
Practice Address - Street 1:1 MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-0001
Practice Address - Country:US
Practice Address - Phone:336-716-2011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-22
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC138543367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered